Strategies for Measuring Prevalence of Disrespect and Abuse During Childbirth

Disrespect and abuse (D&A) during facility-based childbirth has been identified as a widespread problem, but just how commonly it happens is not well understood. Several studies have attempted to measure the prevalence of D&A during childbirth in health facilities across the globe, resulting in a wide range of estimates. Given that variations in reported prevalence may be at least in part the result of differences in definitions, measurement tools and data collection methods, comparing the extent of D&A across diverse settings remains challenging.

In order to better understand the trade-offs related to various methods for measuring the prevalence of D&A, the Maternal Health Task Force – with support from the Bill & Melinda Gates Foundation and the John D. and Catherine T. MacArthur Foundation – conducted a systematic literature review to identify primary studies reporting an estimate of D&A prevalence that were published before August 2016 and collaborated with the authors of five studies identified through this review to compare the methods. The objective of the comparative analysis was to elicit lessons learned from these researchers’ experiences through a detailed review of the pros and cons as well as the potential for systematic error associated with the methods used by this first group of researchers to attempt to quantify the magnitude of D&A during facility-based childbirth. The authors discuss measurement challenges and recommend ways of reducing selection bias, courtesy bias and recall bias to improve future studies.